The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

Quality System Essentials that Support Effective Management and Clinical Practice of Respiratory Care

Susan Blonshine, RRT, RPFT, FAARC Owner & Director of TechEd Consultants

The movement to understand and develop quality systems in healthcare is picking up speed despite the turmoil we face in reimbursement and redesign of services. In the early 1980s industry faced the same challenges healthcare faces today. During that period, a change in management philosophy and the emergence of quality system models occurred such as the ISO 9000 documents and government funded awards such as the Malcolm Baldridge.
The respiratory care profession has been proactive in the quality movement through the development of clinical practice guidelines, protocol development, and studies such as the Muse report. Most recently, the first in a series of discipline specific NCCLS documents, HS4-P, A Quality System Model for Respiratory Services, was published. The guideline provides a structure for a comprehensive, systematic approach to build quality into the respiratory service's processes, assess its performance, and implement quality improvements. Respiratory therapeutics and pulmonary diagnostics were included with specific examples.
The system incorporates ten quality system essentials (QSEs) and a path of workflow for the specific function or service. The QSEs form the basis for the management philosophy of the organization. The path of workflow for each service or function may vary, but the QSEs apply across the path of workflow, regardless of the service. The patient is the central focus of the quality system.
Implementation of the quality system model requires commitment and support of the organization's top-level management, as well as teamwork at all levels. The initial phases of implementation set the foundation and direction for implementing the quality system. The initial phases include:
? Confirmation of leadership commitment;
? Identification of the service's path of workflow;
? Development of the quality manual;
? Development of a system for controlling documents and records;
? Equipment management plan;
? Analysis and validation of processes, development of standard operating procedures (SOPs) and implementation of process controls
The remaining phases of implementation include development of the following:
? Training and competence assessment programs,
? Purchasing and inventory programs,
? Occurrence management program,
? Internal quality indicators and audit programs,
? Process improvement program, and
? Service and satisfaction program
Ultimately, those healthcare systems with the competitive edge will be distinguished through quality management activities.

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